Variation in the management of elderly patients in two neighboring breast units is due to preferences and attitudes of health professionals
Received 10 November 2018
Accepted for publication 19 February 2019
Published 8 May 2019 Volume 2019:11 Pages 179—188
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Pranela Rameshwar
Elizabeth S Morrow,1 Ross D Dolan,1 Julie Doughty,2 Sheila Stallard,2 Alison Lannigan,3 Laszlo Romics1,4
1Academic Unit of Surgery, University of Glasgow, Glasgow, UK; 2Department of Surgery, Gartnavel General Hospital, Glasgow, UK; 3Department of Surgery, Wishaw General Hospital, Lanarkshire, UK; 4Department of Surgery, New Victoria Hospital, Glasgow, UK
Introduction: Elderly breast cancer patients have been shown to be managed less aggressively than younger patients. There is evidence that their management varies between institutions. We audited the management of elderly patients in two neighboring units in Glasgow and aimed to identify reasons for any differences in practice found.
Methods: Patients aged ≥70 years, who were managed for a new diagnosis of breast cancer in the two units between 2009 and 2013, were identified from a prospectively maintained database. Tumor pathology, treatment details, postcode and consultant in charge of care were obtained from the same database. Comorbidities were obtained from each patient’s electronic clinical record. Questionnaires were distributed to members of each multidisciplinary teams.
Results: 487 elderly patients in Unit 1 and 467 in Unit 2 were identified. 76.2% patients in Unit 1 were managed surgically compared to 63.7% in Unit 2 (p<0.0001). There was no difference between the two units in patient age, tumor pathology, deprivation or comorbidity. 16.2% patients managed surgically in Unit 1 had a comorbidity score of 6 and above compared to 11% of surgically managed patients in Unit 2 (p=0.036). Responses to questionnaires suggested that staff at Unit 1 were more confident of the safety of general anesthetic in elderly patients and were more willing to consider local anesthetic procedures.
Conclusion: A higher proportion of patients aged >70 years with breast cancer were managed surgically in Unit 1 compared to Unit 2. Reasons for variation in practice seem to be related to attitudes of medical professionals toward surgery in the elderly, rather than patient or pathological factors.
Keywords: breast cancer, old age, variation in treatment
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